Microsurgical epididymovasostomy in the treatment of occlusive azoospermia

Fogdestam, Ingemar; Fall, Magnus; Nilsson, S.

doi:10.1016/s0015-0282(16)49836-5

Cited by 81 publications

(20 citation statements)

References 5 publications

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“…13,21,29,30,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Most experts in this field agree that the technical experience of the surgeons is one of the most important factors for the success of VE. We reported our clinical experience of microsurgical LIVE in a series of 72 men with azoospermia due to epididymal obstruction.…”

Section: Discussionmentioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy (VE). Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE (LIVE) in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the preoperative evaluation along with the techniques of various VE will be described in this article.

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Section: Discussionmentioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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“…In 18 obstructive azoospermia patients the patency rate after initial epididymova sostomy was 44% [10]. A lthough we performed unilateral end-to-side epididymovaso stomy with the operative microscope in 3 patients [4,12], a successful outcome was achieved only in the Y oung' s syndrom e case. A mong 15 respondents whose sperm had been detected in postoperative ejaculate, 4 case couples achieved natural pregnancy and live birth.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Surgical Treatment for Obstructive Azoospermia

Tsujimura

Matsumiya

Koga

et al. 2002

Archives of Andrology

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“…This concept is in accordance with the experience of other investigators. [2][3][4][5][6] Testicular biopsy prior to scrotal exploration may be indicated in azoospermia with raised FSH and normal-size testes questioning the testicular function, or in severe oligospermia with a normal FSH and testicular volume to differentiate between testicular failure and partial epididymal obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…This has been the experience of other investigators. [5][6][7][8][9][10][11] Microsurgical single-tubule vasoepididymostomy provides anatomic specificity and ensures precise anastomosis; however, it is tedious and requires long experience. We found that the technique of end-to-side vasoepididymostomy through mobilization of a loop of the epididymal tubule and removing an oval window at its vertex is much easier than incising the epididymal tubule while it is in situ and even much better than the end-to end anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…Between 1986 and 1989, vasoepididymostomy was done by the conventional fistula technique with or without splint ( Figure 1). Since October 1989, the vasoepididymostomy has been performed by the microsurgical end-to-side single tubule anastomosis (Figure 2), similar to the technique described by Fogdestam and associates, 5 with some modifications. The epididymis was examined under the operating microscope, looking for the yellowish distended loops of the epididymal tubule which in most cases were seen through the overlying visceral layer of tunica vaginalis.…”

Section: Methodsmentioning

confidence: 99%

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Scrotal Exploration in 123 Azoospermic Patients: The Results of Surgery for Obstructive Azoospermia

Mansi

1995

Annals of Saudi Medicine

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During the last eight years, scrotal exploration for attempted vasoepididymostomy was performed in 123 azoospermic patients at the King Faisal Specialist Hospital and Research Centre. All patients had normal or slightly elevated serum FSH, and normal-size testes (at least on one side). Testicular biopsy was not recommended but had already been done before referral in 73 patients and was reported to show normal spermatogenesis or mild hypospermatogenesis. Vasoepididymostomy could be performed in only 83 (67.5%) patients using the conventional fistula technique in 34 patients and microsurgical single tubule anastomosis in 49 patients. Sixty-seven patients were followed between six and 30 months (mean 17.8 months). Among these patients, 25 produced sperm in the ejaculate with a patency rate of 37.3 percent and seven patients impregnated their wives, for a pregnancy rate of 10.4%. These pregnancies resulted in four living children. The patency rate with the conventional fistula technique was (7/ Azoospermia can result from either failure of the testes to produce sperm or obstruction anywhere along the seminal tract. Small semen volume and a low fructose level in the seminal fluid indicate obstruction at the ejaculatory duct or congenital absence of the vas deferens.1 Epididymal obstruction can result from several congenital and acquired causes. Congenital epididymal abnormalities can range from absence of the body and tail of the epididymis along with the vas deferens, seminal vesicles and ejaculatory ducts to skip areas within the epididymal body and nonunion between the epididymis and the vas deferens. Surgical correction is only feasible when there is a patent vas deferens and sperm within a portion of the epididymis. Acquired epididymal obstruction is more likely to occur within the epididymis secondary to inflammatory processes, vasectomy and iatrogenic injury during transscrotal operations such as spermatocelectomy, testicular biopsy or hydrocelectomy.2 Diagnosis of obstructive azoospermia is supported by normal-size testes, normal serum FSH and normal spermatogenesis on testicular biopsy. Epididymal obstruction is in favor with palpable vas deferens, positive fructose in seminal fluid and distended epididymis.3 Surgically correctable epididymal obstructions are managed by anastomosing the patent vas deferens to the epididymal tubule proximal to the site of obstruction. This can be achieved by basically two techniques: the conventional fistula technique and the microsurgical single tubule anastomosis technique.The epididymal tubule is about 20 feet long, coiled and squeezed into a 2-inch length. The dilated epididymal tubule has a diameter of 0.1 to 0.2 mm.4 Surgery on such a fine structure definitely needs magnification for achieving anatomic specificity and a high percentage of patent anastomosis.We present our experience with scrotal exploration for 123 azoospermic patients, and the results of vasoepididymostomy performed in 83 patients during the last eight years.

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Microsurgical epididymovasostomy in the treatment of occlusive azoospermia

Cited by 81 publications

References 5 publications

The evolution and refinement of vasoepididymostomy techniques

The evolution and refinement of vasoepididymostomy techniques

Outcome of Surgical Treatment for Obstructive Azoospermia

Scrotal Exploration in 123 Azoospermic Patients: The Results of Surgery for Obstructive Azoospermia

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